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When can kids take off their masks in school? Here's what some experts say

A student walks to school in the middle of parent protestors.

When can kids safely take off their masks in school? About three-fourths of the nation's largest districts required masks at the start of the school year. Recently, the calls by some parents to unmask children have grown louder, especially now that there is a COVID-19 vaccine available with emergency authorization for children as young as 5 years old.

The country is still in a pandemic that's killing more than 1,000 Americans every day. And a body of evidence shows masking, in combination with other safety measures, effectively cuts COVID-19 transmission in K-12 schools. Masks are cheaper than renovating school buildings to improve ventilation or create outdoor learning spaces, and they're (still) easier to get ahold of than COVID-19 tests, which can also be used to preempt transmission.

On the other hand, masking has continued, in many cases, into a third school semester. Several months after most adults have been eligible for vaccines, tens of millions of children are spending school days with the bottom half of their faces swathed in either fabric or, in the case of surgical masks, a substance called "melt-blown polypropylene." If they have a long commute, they could be masking for 10 or more hours a day; in some districts, masks are required even outside. Parents are concerned about social development, language learning, skin irritation and mental health.

NPR posed the question of when kids can safely take their masks off in school to scientists and policy leaders in different parts of the country and found a range of nuanced positions and timelines.

Centers for Disease Control and Prevention

When can kids take off their masks? Not now.

In a statement to NPR, a spokesperson said, "CDC continues to recommend universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status or community transmission levels. At this time, there are no changes, however, as the science changes, we will update our guidance as needed." CDC director Rochelle Walensky has backed keeping masks on in schools "as we head into these winter months."

Massachusetts State Department of Elementary and Secondary Education

When? Immediately — with enough vaccinations.

How? A school must demonstrate a vaccination rate of 80% or more of both staff and students. The decision can be made "by local school and district leaders in consultation with local health officials." Schools must collect proof of vaccination of everyone from administrative assistants to after-school staff. Unvaccinated people must keep masking.

Joseph Allen, Harvard T.H. Chan School of Public Health

When? Jan. 1, 2022, once younger children have a chance to get vaccinated.

How? Allen, whose expertise is healthy buildings, is not in favor of a vaccine threshold for unmasking students, given the low risk of COVID-19 to children. He thinks schools should mandate vaccines for adults in school buildings, hold vaccination clinics on-site and provide education to encourage vaccines for kids, and use rapid antigen testing, ventilation and air filtration to lower risk even further.

"I've been a big proponent of mask wearing for a long time, for over a year, but at this point in the pandemic, it no longer makes sense to me," he tells NPR. "If we don't offer paths to removing masks at this point in a pandemic, when risks are low and the tools for protection are there — the vaccine specifically — then we lose trust."

Danny Benjamin, distinguished professor of pediatrics at Duke University, co-chair of the ABC Collaborative

When? January 2022, once younger children have ample chance to get vaccinated.

How? Benjamin of the ABC Collaborative, which has done some of the largest studies showing the efficacy of universal masking in schools, would prefer that 100% of adults in the building are vaccinated or masked, and at least 70% of the children are vaccinated. At "70 to 80 percent, there's a good chance you're going to be successful." And, because risk tolerance varies by district, he says, some districts might go mask-free with as few as half the children vaccinated — if they can accept more COVID-19 transmission as a result.

Amy Falk, pediatrician, Wisconsin Rapids, Wis.

When? "In my heart of hearts," not for a while, but realistically, once children's vaccines have been available for at least several weeks.

"My big holdout is getting every kid protected who wants to be protected. And that, you know, whatever happens after that, I guess everyone's made their choice with it."

Falk is lead author of a widely cited study showing that 90% mask compliance cut COVID-19 transmission within several schools in Wisconsin last fall, even when the spread in the community was high.

Vaccination rates in her community are low — around 50% for adults and even lower for teenagers — and she doesn't expect much better for her younger patients. Opposition to mask mandates, meanwhile, has grown intense. Falk, who offers medical advice to her local school district, has been personally afraid to attend school board meetings since the May 2021 meeting, which she describes as "a very unsafe situation. There was a mass of anti-masking parents and some students. They were heckling us. They were not letting us leave. It was very, very heartbreaking."

Public pressure led to the mask mandate in high schools being lifted this fall, which led in turn, she said, to "massive spread. It was unreal." The board reinstated masking after two weeks. Falk wishes for continued masking, but, she says, "I actually don't know if I think, at a state level, they could pull it off."

Ali Mokdad, professor of global health at the Institute for Health Metrics and Evaluation at the University of Washington

When? Let's not even talk about it until the spring.

Mokdad sees signs of a coming winter COVID-19 surge and of waning immunity from adult vaccination. He implores, "We should not celebrate prematurely. We should be very wise about what's happening right now. We're talking about our children. We're talking about our future."

Jeanne Noble, associate professor of emergency medicine at the University of California, San Francisco, and director of COVID response for the UCSF Emergency Department

When? Dec. 28 in the Bay Area, eight weeks after the FDA's emergency authorization of the vaccine for 5- to 11-year-olds.

How? Noble's recommendation is for schools to follow the metrics the Bay Area has set for unmasking adults in public spaces: low community transmission, low and stable COVID-19 hospitalizations, and high rates of vaccination — currently at 80% of San Francisco residents over 5 years old.

Like Benjamin and the state of Massachusetts, Noble thinks that unmasking once schools reach a threshold of 70% to 80% vaccination rates for students would be fine, even conservative. But she says going by community metrics is preferable because it's simpler and more consistent. Dr. Noble is one of the authors of a petition signed by 150 Bay Area medical professionals, asking the state of California to create a clear masking off-ramp for schools.

"People are tired of this," Dr. Noble says. "There's a sense, I think, in a child's life, particularly, that things are never going to change." She says that parents need to be able to give kids hope by telling them that a day is coming when they will be able to play at school with their friends without masks on. ​​

Pennsylvania Gov. Tom Wolf

When? Jan. 1, 2022

On Nov. 9, Wolf, a Democrat, announced the statewide K-12 mask mandate will lift on Jan. 1. He's not tying it to any requirements around student vaccination but is leaving the decision to local jurisdictions.

Outgoing New York City Mayor Bill de Blasio

When? Not yet. The Democratic mayor, who oversees the country's largest school district, said at a news conference that the mandate would stay in place "out of an abundance of caution."

Incoming New York City Mayor Eric Adams:

When? He told CNN he "looks forward to it ... if we can find a safe way to do it."

Copyright 2021 NPR. To see more, visit https://www.npr.org.